Everything You’ve Ever Wanted to Know About Thread Lifts

This article first appeared in the Summer 2019 issue of NewBeauty. Click here to subscribe.

As with most reboots, thread lifts are
haunted by disappointments past. The early
2000s version—“permanent polypropylene
threads with coarse barbs laid in a way that
was not physiologically sound,” explains
Chicago plastic surgeon Julius Few, MD—was riddled with flaws, from visible bunching
that lasted weeks and potential skin perforations years later to asymmetric breaking of
the threads and lack of efficacy. “I was
practicing when the original threads came
out, but I never used them because I felt they
were poorly conceived,” says Dr. Few, who is
now the country’s top user of the Silhouette
InstaLift, a next-gen dissolvable device comprising polyglycolide/l-lactide threads studded
with tissue-gripping cones intended to temporarily hoist the midface. (Rival brands like
Nova Threads and MINT make similar products from polydioxanone, a safe biocompatible
material that’s long been used in Asia).

The Debate Over EfficacyDr. Few, who is also an investigator and
consultant for Silhouette, makes a point of
referring to the minimally invasive procedure
by its official name—“absorbable suture
suspension”—rather than the colloquial
“thread lift,” a term he says they’re trying
to get away from. Ghostbusting in action.

Silhouette, he believes, is “really something
different.” In more than 1,000 cases, he’s never
seen an infection; a thread snap or extrude;
“or any folding or bunching of the skin that
lasted more than overnight and wasn’t truly
minor in nature—barely visible.” The fact that
Silhouette is completely reabsorbed by the
body after nine to 12 months makes it less
risky. As the threads dissolve, they stimulate
the body to make more of its own collagen for
a lift that lasts between two and three years,
according to Dr. Few’s most recent data—which, by the way, is something else that
distinguishes Silhouette from threads of old:
“Where we are now, data speaks,” he says.
“In the past, it was all hype, no studies.”

The greatest danger with these modern threads, warns Dr. Few, is pushing the
envelope. The ideal candidate (usually in
her 30s or 40s) has relatively good facial
volume and skin quality with mild-to-
moderate sagging—“meaning the central
part of the face is just beginning to droop,
making the eyelids look tired and the
cheeks look older, and the jawline is start-
ing to get a bit irregular and form a jowl,”
he says. “In those cases, I can get a complete
correction that makes surgery temporarily
unnecessary. It’s super predictable and
there’s little downtime” (a few days of swell-
ing and bruising). For people in their late
50s and 60s, results can be hit-or-miss,
and oftentimes “a classic facelift is going to
reset the clock in a more dramatic way and
last longer,” he notes, rendering patients
refreshed for a good 10 years or more.
Surgery may also be a better bet for those
whose necks have aged beyond their years.

“The majority of patients who’ve done this
once want to do it again, and that’s a strong
endorsement,” he says. But not ringing
enough to sway every surgeon. “I think it’s
a placebo,” says Corona Del Mar, CA plastic surgeon Val Lambros, MD. “I don’t think
the operation works, and there’s an anatomic reason for that: The face is held onto
the bone by lots of tiny ligaments, which in
aggregate are very strong, but individually,
are quite weak,” he explains. It’s these
ligaments that the threads and cones aim to
snag and anchor onto. “They’re not catching
something with a lot of strength to it, and
once you start pursing your lips and smiling,
the threads can release from the ligaments.”

Indeed, some thread lift studies show
improvements lasting less than six months,
but there are many different brands and
styles of threads, and not all are created
equal. Dr. Few contends his “scientific
conclusions [on Silhouette specifically] are
supported by extensive research published
in multiple peer-reviewed journals.” For best
results, find a board-certified dermatologist
or plastic surgeon with significant thread-
lifting experience.